The report prepared by Kitty Hendricks and colleagues at the National Institute for Occupational Safety and Health(NIOSH) describes injuries to youth living on U.S. farms. The authors provide an important contribution to our national initiative on childhood agricultural injury prevention. By comparing 1998 baseline data obtained from a national sample of farm households to data collected three years later, we are able to understand major changes in the population at risk as well as subtle injury trends that could be addressed through intervention programs. Further, the lessons learned from this surveillance effort demonstrate the valuable contribution that NIOSH has made in an arena heretofore not formally addressed by any federal agency - because the population of concern is a mix of "occupation" and "children" this issue previously was of peripheral interest for most public agencies. In 1996, a committee comprised of 42 individuals from across the country developed a national action plan that was endorsed by 80 organizations representing agriculture, public health, injury prevention, occupational safety, and youth-serving groups.1 This action plan, approved by Congress with a $5 million appropriation, designated NIOSH as the lead agency for its implementation. NIOSH quickly established both intramural and extramural programs to tackle high priority research, injury surveillance, and communication strategies. Among the 13 objectives was, "Establish and maintain a comprehensive national database of fatal and nonfatal childhood agricultural injuries." NIOSH scientists designed the Childhood Agricultural Injury Survey (CAIS) with input from injury epidemiologists representing Centers for Disease Control and Prevention Injury Research Centers and survey researchers from the National Agricultural Statistics Service. Different project phases, using methodologies for special populations, have provided valid statistics that enabled us to clear the foggy picture of nonfatal injuries affecting young workers on farms and children who live on or visit farms. While there's no perfect system for collecting retrospective injury data on children, the NIOSH team has done a remarkable job of collecting and disseminating data that shapes our injury prevention efforts for youth in agriculture. This report informs us that the majority of all childhood agricultural injuries continue to affect household youth, that is, children who live on a family farm. Over a three-year period the population at risk has declined by 15%, associated with the decrease in total number of farms and fewer children per farm. This fact probably accounted for the major drop (29%) in the overall number of injuries among household farm youth. The rate of injuries dropped only 3.1% during the three-year period; and while not statistically significant, it is promising. Several findings suggest opportunities to fine-tune our intervention programs. Injuries among males have declined while those for females have increased. Tractor-related injuries among youth showed a substantial decline while injuries associated with horses and ATVs both increased. NIOSH leaders, and in particular the Childhood Agricultural Injury team located in Morgantown, WV, should be commended for planning, implementing and maintaining this injury surveillance initiative. Given the vicissitudes of federal agency directives, combined with the reluctance of agricultural producers to reveal more than necessary about their farms, the fact that we now have these data is a minor miracle. These data have been reported at conferences, in journals, in NIOSH reports and on the web (http://www.cdc.gov/niosh/topics/childag/
). Let's all keep up our support for NIOSH and hope to see the next round of CAIS results in 2007!